Regrettably, many Americans choose to focus their attention on trivial distractions while we face many serious challenges: The economy continues to struggle and likely will continue to struggle, children of the poor are inadequately educated, computers are rapidly changing our lives in ways we do not understand and we spend enormous sums on health care, yet our life expectancy lags well behind other developed nations.

These are just a few of the many challenges we face, each of which impacts us and our patients in a variety of ways.

The struggling economy increases the number of unemployed/ underemployed, which decreases the number of insured patients, the Affordable Care Act notwithstanding. One of the best predictors of health status is education level. By not educating children well, we set them up for more health problems as they age. Computers dramatically affect our work every day. Hard to imagine what medical practice will be like in 30 years.

A key concern of mine is the challenge posed by the very expensive care we provide that somehow still results in a shorter life expectancy than in peer nations. Regardless of who wins the elections in 2014, 2016, 2020 and beyond, the cost of U.S. health care must stop increasing faster than inflation. We literally cannot afford the care we provide.

Previously, as physicians, we could act as a group to limit cost increases, but changes are now taking this ability out of our hands. For example, U.S. health insurance routinely includes high deductibles. Not long ago, a $3,000 deductible was unusually high. Now, it is common and nowhere near the upper limits of normal deductible rates.

Another cost-control tool is charge transparency. Everyone should be aware that in August, Connecticut will start posting charges for common procedures. The public posting in Connecticut of quality data does not yet significantly impact patient preference, but data from other states shows there is a major impact there from posting charges. I expect Connecticut will be just like Massachusetts in this regard. The combination of high deductibles and charge transparency should result in substantial shifts in the way health care is delivered in our area.